EBM Sept 2020 Flashcards
What type of fractures are patients on bisphosphonates at risk for?
Atypical Fractures increase with duration
Asians > Whites
Risk of atypical fractures are less than that of osteoporotic fractures
Black DM, Geiger EJ, Eastell R, et al. Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates. N Engl J Med. 2020 Aug 20;383(8):743-753. doi: 10.1056/NEJMoa1916525.
What is the USPSTF recommendation for counseling to reduce STI? (2020)
2020 Statement: The USPSTF concludes with moderate certainty that behavioral counseling interventions reduce the likelihood of acquiring STIs in sexually active adolescents and in adults at increased risk, including for example, those who have a current STI, do not use condoms, or have multiple partners, resulting in a moderate net benefit.
Krist AH, Davidson KW, Mangione CM, et al. Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: US Preventive Services Task Force Recommendation Statement. JAMA. 2020 Aug 18;324(7):674-681. doi: 10.1001/jama.2020.13095.
Do SGLT-2 inhibitors lead to below the knee amputations?
Overall, the studies are inconsistent
However, per this study, no
- 11 months prospective observational study
- 200k SGLT2 vs 200k DPP4i patients
Positives: Prospective, large comparison
Negatives: Short follow up
Yu OHY, Dell`Aniello S, Shah BR, et al. Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of Below-Knee Amputation: A Multicenter Observational Study. Diabetes Care. 2020 Aug 5. pii: dc20-0267. doi: 10.2337/dc20-0267.
Do PAPR (Powered Air Purifying Respirators) more protective in regards to contracting respiratory illnesses compared to other respiratory equipment?
Low quality evidence
Doesn’t appear to be
Licina A, Silvers A, Stuart RL Use of powered air-purifying respirator (PAPR) by healthcare workers for preventing highly infectious viral diseases-a systematic review of evidence. Syst Rev. 2020 Aug 8;9(1):173. doi: 10.1186/s13643-020-01431-5.
Does endovascular therapy for (IACS) intracranial atherosclerotic stenosis in symptomatic stroke prevent recurrent strokes compared to conventional medical therapy (e.g. anti platelets)?
No
Showed increased risk for stroke or death, ipsilateral stroke, ischemic stroke and hemorrhagic stroke in 30 days and 1 year
Con: high risk of bias, 600 people, 3 studies
What is the relationship between neurosyphilis in primary, secondary and tertiary syphilis?
Neurosyphilis can occur in any of the stages, that is, it can occur in primary, secondary or tertiary syphilis.
What is the most common presentation of ocular syphilis?
Panuveitis with loss of vision acuity
What are the options to induce remission in moderate to severe ulcerative colitis?
According to AGA guidelines 2019:
– steroids – TNF alpha inhibitors: infliximab, golimumab, adalimumab - Integrated inhibitor: vedolizumab - JAK inhibitor: tofacitinib - IL 12/23 inhibitor: Ustekinumab
Rarely is there a condition that requires annual colonoscopy screening for colon cancer.
In what situation for ulcerative colitis does a patient require yearly colonoscopy screenings for colon cancer?
UC plus PSC
In general, following the diagnosis of ulcerative colitis, when should a patient receive his or her first colonoscopy for colon cancer screening?
Eight years after diagnosis
AGA guidelines 2019
What type of infections are patients at risk for when taking Baricitinib?
Herpes Zoster
-Review: JAK kinase inhibitor
Winthrop KL, Harigai M, Genovese MC, et al. Infections in baricitinib clinical trials for patients with active rheumatoid arthritis. Ann Rheum Dis. 2020 Aug 11. pii: annrheumdis-2019-216852. doi: 10.1136/annrheumdis-2019-216852.
What is the first choice for inducing remission in patients with mild to moderate Ulcerative Colitis?
Oral 5 aminosalicylic acid (addition of 5-ASA enema with extensive left sided colitis)
Murray A, Nguyen TM, Parker CE, et al. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2020 Aug 12;8:CD000543. doi: 10.1002/14651858.CD000543.pub5.
What type of diabetic patients will benefit from intensive glucose control to decrease the development of MACE (Major Adverse Cardiovascular Events)?
Patients with short duration of diabetes, no previous cardiovascular events and long life expectency - AKA newly diagnosed diabetes w/o complications
Review: Generally, intensive glucose control has only demonstrated to decrease microvascular complications - Not macro
Prattichizzo F, de Candia P, De Nigris V, et al. Legacy effect of intensive glucose control on major adverse cardiovascular outcome: Systematic review and meta-analyses of trials according to different scenarios. Metabolism. 2020 Sep;110:154308. doi: 10.1016/j.metabol.2020.154308. Epub 2020 Jul 4.
Does genotype testing patients with ACS who receive PCI for CYP2C19*2 or *3 loss-of-function (LOF) variants and then prescribing them the appropriate P2Y12 inhibitor (Clopidogrel vs Ticagrelor) reduce cardiac events?
TAILOR-PCI Trial
No difference between the two groups
The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, stent thrombosis, and severe recurrent ischemia at 12 months.
Pereira NL, Farkouh ME, So D, et al. Effect of Genotype-Guided Oral P2Y12 Inhibitor Selection vs Conventional Clopidogrel Therapy on Ischemic Outcomes After Percutaneous Coronary Intervention: The TAILOR-PCI Randomized Clinical Trial. JAMA. 2020 Aug 25;324(8):761-771. doi: 10.1001/jama.2020.12443.
Does supplementing Vitamin D deficient Asthma patients with Vit D3 reduce severe asthma exacerbations?
No
Double blind RCT
90 patients vs 90 patients
Forno E, Bacharier LB, Phipatanakul W, et al. Effect of Vitamin D3 Supplementation on Severe Asthma Exacerbations in Children With Asthma and Low Vitamin D Levels: The VDKA Randomized Clinical Trial. JAMA. 2020 Aug 25;324(8):752-760. doi: 10.1001/jama.2020.12384.
